Healthcare Provider Details

I. General information

NPI: 1700515871
Provider Name (Legal Business Name): CRISTINE DIEZ CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. DE HOSTOS, EDIFICIO OFFICE PARK SUITE 406
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

EXT SABALOS GARDENS EDF 6 APT 54
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-9133
  • Fax:
Mailing address:
  • Phone: 939-238-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: